Low profile catheter assembly

ABSTRACT

A medical catheter assembly includes a catheter hub, an elongate catheter member extending from the catheter hub and having at least one longitudinal lumen for passage of fluids, an extension tube extending from the catheter hub and defining an internal lumen in fluid communication with the at least one longitudinal lumen of the catheter member and a clamp positionable about the extension tube. The catheter hub defines a reduced profile to facilitate passage of the catheter hub through a surgical tunnel. The clamp includes first and second clamp sections and defines a longitudinal clamp axis. The clamp has a longitudinal opening for passage of the extension tube and a movable member adapted to move from a first position to a second position to substantially close the internal lumen. The first and second clamp sections are separable to facilitate transverse positioning of the clamp sections about the extension tube.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation application of U.S. application Ser. No. 11/528,913, filed Sep. 28, 2006, the entire contents of which is hereby incorporated by reference.

BACKGROUND

1. Technical Field

The present disclosure is directed to a catheter assembly, and, in particular, relates to a low-profile catheter system adapted for use in a subcutaneous tunneling catheterization procedure.

2. Description of the Related Art

Catheters are flexible medical instruments intended for the withdrawal and introduction of fluids relative to body cavities, ducts, and vessels. Catheter instrumentation may have particular application in a hemodialysis procedure where blood is withdrawn from a blood vessel for treatment, and subsequently returned to the blood vessel for circulation. Known hemodialysis catheters include multiple lumens, such as dual lumen or triple-lumen catheters, permitting bi-directional fluid flow within the catheter whereby one lumen is dedicated for withdrawal of blood and the other lumen is dedicated for returning the treated blood to the vessel. During an exemplary hemodialysis procedure, a multiple lumen catheter is inserted into a body and blood is withdrawn through an arterial lumen of the catheter. The removed blood is directed to a hemodialysis unit which dialyzes, or purifies, the blood to remove waste, and toxins. The dialyzed blood is returned to the patient through a venous lumen of the catheter.

Various techniques are employed for the insertion of hemodialysis catheters including, e.g., with the use of guidewires, introduction stylets or the like. Some of these known techniques include subcutaneous tunneling methodologies where a subcutaneous tunnel is formed between two spaced openings in the skin with the use of a trocar or the like. The catheter end is attached to the trocar and pulled though the tunnel to expose the catheter which is subsequently inserted into, e.g., the jugular vein and routed to the heart.

SUMMARY

Accordingly, the present disclosure is directed to further improvements in hemodialysis catheters and systems used therewith. A medical catheter assembly includes a catheter hub having a reduced profile, an elongate catheter member extending from the catheter hub and having at least one longitudinal lumen for passage of fluids, an extension tube extending from the catheter hub and defining an internal lumen in fluid communication with the at least one longitudinal lumen of the catheter member and a clamp positionable about the extension tube. The clamp includes first and second clamp sections and defines a longitudinal clamp axis. The clamp has a longitudinal opening for passage of the extension tube and a movable member adapted to move from a first position to a second position to substantially close the internal lumen. The first and second clamp sections are separable to facilitate positioning of the extension tube within the longitudinal opening, e.g., subsequent to positioning the elongate catheter member within the subject. The first and second clamp sections may be releasably mounted to each other along the longitudinal clamp axis to facilitate lateral positioning of the extension tube within the longitudinal opening of the clamp. The first and second clamp sections may include a pin and corresponding slot mechanism for effecting releasable mounting of the first and second clamp sections. The first and second clamp sections may be connected by a tether.

In one preferred embodiment, the clamp includes a clamp base defining the longitudinal opening and has the movable member mounted thereto. The movable member is pivotally mounted to the clamp base and is adapted to pivot relative to clamp base between the first and second positions thereof. Means for releasably securing the movable member in the second position may be provided. The clamp base may include an internal locking shelf dimensioned to engage the movable member to secure the movable member in the second position.

The medical catheter assembly may include first and second extension tubes which are connectable to the catheter hub. The catheter hub defines first and second extension conduits for respectively receiving the first and second extension tubes. The first and second extension conduits may be arranged in side by side relation. Preferably, the first extension conduit is arranged about an axis in substantial parallel relation with a longitudinal hub axis of the catheter hub. The second extension conduit is arranged about an axis in oblique relation with the longitudinal hub axis of the catheter hub. First and second adapters may be mounted to each of the first and second extension tubes. The first extension tube and the first adapter define a first effective length which is substantially less than a corresponding second effective length of the second extension tube and the second adapter. Preferably, the first effective length is less than a length of the second extension tube to permit the first extension tube and the first adapter to be positioned in adjacent side by side relation with respect to the second extension tube thereby reducing the profile thereof to facilitate passage through tissue.

The catheter hub may define a pair of suture wing holes for receiving a suture utilized in securing the catheter hub. Alternatively, the catheter hub defines an outer groove dimensioned for accommodating a suture utilized in securing the catheter hub.

In another embodiment, a low profile catheter hub for an elongate dual lumen catheter includes a catheter hub member adapted for connection to a dual lumen catheter. The catheter hub member defines a longitudinal hub axis and has first and second conduits therein adapted for fluid connection to respective fluid supply and/or withdrawal tubing. The first fluid conduit is arranged about a first axis extending in substantial parallel relation with the longitudinal hub axis. The second fluid conduit is arranged about a second axis in oblique relation with the longitudinal axis.

A clamp for closing compressible medical tubing is also provided. The clamp includes a clamp member defining a longitudinal clamp axis. The clamp member includes first and second clamp sections and has a longitudinal opening for passage of compressible tubing. The clamp member includes a movable member adapted to move from a first position to a second position to substantially close a lumen of the compressible tubing. The first and second clamp sections are releasably mountable to each other whereby the first and second clamp sections may be separable generally along the longitudinal clamp axis to permit access to the longitudinal opening to facilitate positioning of the compressible tubing within the longitudinal opening. The first and second clamp sections may be connected by a tether.

The first and second clamp sections include a pin and corresponding slot mechanism for providing a releasable mounting of the first and second clamp sections. The clamp member may include a clamp base defining the longitudinal opening and having the movable member pivotally mounted thereto. The movable member is adapted to pivot relative to the clamp base between the first and second positions thereof. The clamp base may include an internal locking shelf dimensioned to engage the movable member to secure the movable member in the second position.

A method for performing a surgical procedure is also disclosed. The method includes the steps of:

providing a catheter including a catheter hub and an elongated catheter extending from the hub, the elongated catheter having at least one longitudinal lumen for passage of fluids;

accessing an underlying tissue site through an opening in the skin of a patient;

advancing a distal end of the elongated catheter through the tissue site and into the patient;

creating a surgical tunnel from the tissue site and out through a second opening in the skin remote from the first opening;

passing the catheter through the surgical tunnel by introducing the catheter hub through the first opening and advancing the catheter hub with the elongated catheter following there along within the surgical tunnel; and

fluidly coupling the at least one longitudinal lumen of the catheter with an external fluid source.

BRIEF DESCRIPTION OF THE DRAWINGS

Preferred embodiments of the disclosure will be better understood with reference to the accompanying drawings wherein:

FIG. 1 is a perspective view of the low-profile catheter of the system in accordance with the principles of the present disclosure;

FIG. 2 is a perspective view with parts separated illustrating the components of the low-profile catheter of FIG. 1;

FIG. 3 is a side cross-sectional view of the low-profile catheter;

FIG. 4 is a perspective view of an alternate embodiment of the catheter hub of the low profile catheter;

FIGS. 5-6 are perspective views illustrating the leading end of the low profile catheter;

FIG. 7 is a side plan view of the leading end of the low profile catheter system taken along the lines 7-7 of FIG. 1;

FIG. 8 is a cross-sectional view of the low profile catheter taken along the lines 8-8 of FIG. 1;

FIG. 9 is a perspective view of the clamp of the low-profile catheter;

FIGS. 9A-9B are each perspective views illustrating the clamp of FIG. 9 in a non-assembled condition;

FIG. 9C is a view of an area of detail identified in FIG. 3 illustrating the clamp positioned about the extension tube and in a first open position;

FIG. 9D is a view similar to the view of FIG. 9C illustrating the clamp in a second closed position;

FIGS. 10A and 10B are perspective views of alternate embodiments of the clamp;

FIG. 11 is a side plan view of the low profile catheter with the clamps removed;

FIG. 12 is a side plan view similar to the view of FIG. 11 with the extension tubes twisted prior to insertion within the surgical site;

FIG. 13 is a side plan view illustrating a tunneling instrument and the extension tube adapter;

FIG. 14 is a side plan view illustrating the tunneling instrument mounted to the extension tube adapter and a sheath positioned about the connection location; and

FIG. 15 is a perspective view illustrating an embodiment of the sheath of FIG. 14;

FIGS. 16-17 are views illustrating a methodology of insertion of the low profile catheter through a reverse tunneling procedure to access the right atrium of the heart; and

FIG. 18 is a view illustrating at least partial removal or retraction of the sheath to expose the adapters for connection to a hemodialysis machine.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The exemplary embodiments of the catheter and methods of use disclosed are discussed in terms of medical catheters for the administration of fluids (withdrawal or introduction) relative to the body of a subject and, more particularly, in terms of a hemodialysis catheter. However, it is envisioned that the present disclosure may be employed with a range of catheter applications including surgical, diagnostic and related treatments of diseases and body ailments of a subject. It is further envisioned that the principles relating to the catheter disclosed include employment with various catheter related procedures, such as, for example, hemodialysis, cardiac, abdominal, urinary, intestinal, and in chronic and acute applications. Moreover, the catheter can be used for administration of fluids such as, for example, medication, saline, bodily fluids, blood and urine.

In the discussion that follows, the term “proximal” or “trailing” will refer to the portion of a structure that is closer to a clinician, while the term “distal” or “leading” will refer to the portion that is further from the clinician. As used herein, the term “subject” refers to a human patient or other animal. The term “clinician” refers to a doctor, nurse or other care provider and may include support personnel.

The following discussion includes a description of the catheter system, followed by a description of an exemplary method of operating the catheter in accordance with the principles of the present disclosure. For discussion purposes, the catheter will be discussed in terms of a hemodialysis catheter and the method of operation will be discussed in terms of a reverse tunneling procedure utilized for positioning the catheter during a dialysis procedure. However, those skilled in the art will appreciate the catheter has many other applications in addition to dialysis applications.

Referring now to the figures wherein like components are designated by like reference numerals throughout the several views, FIGS. 1-2 illustrate in perspective views, the hemodialysis catheter 10 in accordance with the principles of the system of the present disclosure. Catheter 10 includes several components assembled together, namely, catheter hub or housing 12, elongated catheter member 14 extending distally from the catheter hub 12 and first and second extension tubes 16, 18 extending proximally from the catheter hub 12. Catheter system 10 further includes a pair of clamps 20 which are mountable about each of extension tubes 16, 18.

With reference now to FIGS. 1-3, catheter hub 12 is advantageously dimensioned for engagement by the clinician. Moreover, catheter hub 12 defines a reduced profile particularly when viewed along the longitudinal housing axis “k” (FIG. 2) of the catheter hub 12. Housing axis “k” is in general alignment with axis “m” of catheter member 14. Catheter hub 12 includes proximal or trailing housing section 22 adjacent extension tubes 16, 18 and distal or leading housing section 24 adjacent catheter member 14. As best depicted in FIG. 3, proximal housing section 22 defines first and second internal extension conduits 26, 28 extending along the housing axis “k” and separated by septum wall 30 of catheter hub 12. First extension conduit 26 is in general parallel relation with the housing axis “k”. Second extension conduit 28 is arranged at an acute angle “b” with respect to the housing axis “k”. Angle “b” may range from about 0 degrees to about 45 degrees relative to the housing axis “k”, more preferably, about 5 degrees to about 20 degrees relative to the housing axis “k”. This parallel arrangement of first extension conduit 26 coupled with the slight oblique arrangement of second extension conduit 28 significantly reduces the profile of catheter hub 12 particularly compared to conventional catheter hub designs which employ a v- or t-shaped shaped conduit connection areas.

First and second extension conduits 26, 28 are adapted to receive respective first and second extension tubes 16, 18 in secured relation therewith. In one preferred embodiment, extension tubes 16, 18 are secured within the respective extension conduits 26, 28 via an interference or frictional fit. It is also envisioned that cements or adhesives may be utilized to secure extension tubes 16, 18 within their respective extension conduits 26, 28. Distal or leading housing section 24 of catheter hub 12 defines central opening 32 which receives catheter member 14. Catheter member 14 may be secured within central opening 32 of distal housing section 24 via an interference or frictional fit, and, possibly supplemented with cements and adhesives or the like.

Catheter hub 12 may further include a pair of opposed suture wings 34 along its outer surface. Suture wings 34 define openings 36 dimensioned for receiving sutures which may be utilized in securing catheter hub 20 relative to the subject. In an alternative embodiment depicted in FIG. 4, catheter hub 20 may have an annular groove 36 a in its outer wall in lieu of suture wings 34. A suture may be wrapped within annular groove 36 a and subsequently secured relative to the subject.

Referring now to FIGS. 5-8, in conjunction with FIG. 3, elongated catheter member 16 will be discussed. Catheter member 14 is preferably a dual lumen catheter having first and second longitudinal lumens 38, 40 separated by a septum wall 42 which extends the length the catheter member 14 (FIG. 3). Each of the first and second longitudinal lumens 38, 40 may define a D-shaped opening in cross-section. Other lumen arrangements are also envisioned including circular, pie shaped or other shapes known in the art. Coaxial lumens are also envisioned. Septum wall 42 of catheter member 14 preferably abuts septum wall 30 of catheter hub 20 in the assembled condition of the components. Thus, with this arrangement, low profile catheter 10 defines a dual lumen catheter, inclusive of a first lumen including extension conduit 26 and first longitudinal lumen 38 of catheter member 14, and a second lumen inclusive of extension conduit 28 and second longitudinal lumen 40. Single or triple lumen catheters are also envisioned.

With particular reference to FIGS. 5-7, leading or distal end 44 of catheter member 16 will be discussed. The arrangement of catheter distal end 44 is similar to an embodiment disclosed in commonly assigned U.S. Patent Application No. 2005/0267400 to Haarala et al., the entire contents of which are incorporated herein by reference. In particular, distal end 44 of catheter member 16 includes a pair of opposed openings 46, 48 arranged in its outer wall in diametrical relation and in fluid communication with respective first and second longitudinal lumens 38, 40. Each opening 46, 48 is characterized by having an arcuate recessed wall surface 50 to define a partial generally arcuate opening a shown. Openings 46, 48 are symmetrically arranged about the longitudinal axis “m” of catheter member 14. Preferably, septum wall 42 of catheter member 16 extends distally beyond catheter member 14. Catheter member 14 further includes a pair of polygonal or parallelpiped openings 52 in fluid communication with first and second longitudinal lumens 38, 40 and openings 46, 48. Openings 52 are disposed proximal of openings 46, 48 as shown. Openings 46, 48 and proximal openings 52 permit passage of fluids during the surgical procedure. Further details regarding distal end 44 of catheter member 14 may be ascertained by reference to the Haarala '400 publication. Other arrangements, e.g., as disclosed as alternate embodiments in the Haarala '400 publication, are also envisioned.

Catheter member 14 is preferably flexible and may be formed by conventional injection molding or extrusion means. The wall of catheter member 14 may include reinforcing material if desired. Catheter member 14 may have a pre-curved configuration in its normal state, i.e., have a preformed bend which it normally assumes in the absence of an external stressor to confirm to a body cavity or vessel in which the catheter member is to be positioned. Alternatively, catheter member 14 may be devoid of any normally curved orientation.

Referring again to FIGS. 1-3, catheter member 14 may further include at least one cuff 54 on its outer surface. Cuff 54 may include a fabric material and functions to be a site for tissue ingrowth for long term securing of catheter 10 in an indwelling position. For example, cuff 54 may reside in the tunnel formed during the tunneling procedure. More than one cuff 54 may also be provided. Catheter member 14 may also include radiopaque markings or strips to facilitate the location of catheter within the body with a fluoroscope.

First and second extension tubes 16,18 may be any suitable tubing adapted to supply or withdrawal fluid to or from a body vessel. First and second extension tubes 16,18 preferably include a compressible material whereby the tubes 16,18 may be selectively compressed via clamps 20 to substantially close the opening within the tubes 16,18. The free or trailing ends of extension tubes 16,18 remote from catheter hub 12 have adapters 56 mounted thereto. Adapters 56 may be any conventional luer connector or adapter utilized in a surgical environment for administrating fluids. One suitable connection is a luer connector which may incorporate an external thread or cam 58 for securing to a fluid source. Adapters 56 may be secured to extension tubes 16,18 by any of the aforementioned means including friction or tolerance fit, adhesives, cements, or the like. As best depicted in FIGS. 1-2, adapters 56 each include outer walls having a pair of recessed surfaces 60. Recessed surfaces 60 are ergonomically designed to be engaged by the clinician thereby facilitating manipulation of the catheter 10 about the operative site.

First tube extension 16 may define a length which is less than second tube extension 18. In one preferred embodiment, the overall effective length of first extension tube 16 and its attached adapter 56 is less than the corresponding overall effective length of second extension tube 18 and its adapter 56. As a further preference, the overall effective length of first extension tube 16 and its adapter 56 is less than or equal to the length of second extension tube 18. With this arrangement, first extension tube 16 and its adapter 56 may be placed in juxtaposed or side-by-side relation with the second extension tube 18 to substantially reduce the profile presented by the first and second extension tubes 16, 18. The significance of this feature will be appreciated from the description provided hereinbelow. First and second extension tubes 16,18 may define the same lengths if desired.

Referring now to FIGS. 9-9D, in conjunction with FIG. 3, clamps 20 will be discussed. Clamps 20 are mounted about first and second extension tubes 16,18. Each clamp 20 is adapted to move from a first open position in non compressive engagement with the respective extension tube 16,18 (FIG. 9C) to a second substantially closed position to compress the respective extension tube (16, 18) and close the lumen within the tube (FIG. 9D) thereby preventing fluid flow in either direction. Each clamp 20 defines a longitudinal clamp axis “t” and longitudinal opening or passage 62 for reception of extension tube 16,18. Longitudinal passage 62 is inclusive of first and second openings 64, 66 within opposed end walls 68,70 of the clamp 20 and the central interior of the clamp 20.

Each clamp 20 includes two sections, namely, first clamp section 20 a and second clamp section 20 b which is releasably mountable to the first clamp section. In one preferred arrangement, first clamp section 20 a includes openings 72 in side wall 74. Second clamp section 20 b includes pins 76 extending in transverse relation from side wall 78. Pins 76 are advantageously dimensioned to be received in the openings 72 of first clamp section 20 a in snap relation therewith whereby, upon mounting of the second clamp section 20 b to the first clamp section 20 a, the clamp 20 becomes a single unit. Preferably, in use, the respective extension tube 16, 18 is positioned through the cutaway portions 80, 82 (FIG. 9A) leading to respective openings 64, 66 of the first clamp section 20 a. Thereafter, second clamp section 20 b is mounted to first clamp section 20 a as discussed hereinabove.

Clamp 20 further includes internal wedge surfaces 84,86 arranged in opposed relation as shown. Upon movement of clamp 20 from the first open position of FIG. 9C to the second closed position of FIG. 9D, wedge surfaces 84,86 engage extension tube 16, 18 in a manner to close the opening within the extension tube 16, 18 to thereby prevent passage of fluid within the tube 16,18. Clamp 20 further includes a locking mechanism to secure clamp 20 in the in the second closed position. The locking mechanism preferably includes locking surface 88 disposed on the cantilevered section of clamp 20 which engages locking ledge 90 to secure the clamp 20 in the second closed position. In general, clamp 20 includes clamp base 92 having wedge surface 86 and movable member 94 having wedge surface 84 mounted via a pivoting, hinge, living hinge, or cantilever arrangement to the clamp base 92. Movable member 94 is adapted to move or pivot between the first open position and the second closed position of FIGS. 9C, 9D respectively.

FIG. 10A illustrates an alternate embodiment of the clamp. Clamp 20 is substantially similar to the clamp 20 described in connection with FIGS. 9-9D. However, in accordance with this embodiment, clamp 20 further includes tether 95 connected to clamp sections 20 a, 20 b. Tether 95 may be integrally connected to clamp sections 20 a,20 b or monolithically formed with the clamp sections 20 a,20 b. Tether 95 functions to operatively couple clamp components 20 a, 20 b to facilitate manipulation and/or connection of the clamp components at the operative site.

FIG. 10B illustrates an alternate embodiment of clamp 20. Clamp 96 is substantially similar to clamp 20 discussed hereinabove, but is a single piece component. Clamp 96 further defines cut away portions 97,99 on opposed lateral sides of clamp 96 in communication with openings 64,66 respectively. It is also envisioned that cut away portions 97,99 may be on the same side of clamp 96. Thus, clamp 96 may be mounted about an extension tube 16,18 by passing the tube between movable member 94 and base member 92 through spacing 98 with clamp 96 in the open position of FIG. 10B. Sections of the respective tubing 16,18 may be passed through cut away portions 97,99 for reception within openings 64, 66. In one embodiment, portions 97 a,99 a of clamp base 92 defining respective cut away portions 97,99 are relatively narrow adjacent one lateral side to facilitate retention of the tube upon positioning of the tube within longitudinal passage 62 of clamp 20. Clamp 96 functions substantially in a similar manner to that described in connection with clamp 20.

The components of catheter 10 are fabricated from materials suitable for medical applications, such as, for example, polymerics or metals. Suitable metals include titanium or stainless steel, depending on the particular catheter application and/or preference of a practitioner. Semi-rigid and rigid polymerics are contemplated for fabrication, as well as resilient materials, such as molded medical grade polyurethane, and silicone. The sealing components of catheter 10 may be fabricated from low friction property materials such as, polytetrafluoroethylene (PTFE) coated, PTFE impregnated and/or internally lubricated elastomers. One skilled in the art, however, will realize that other materials and fabrication methods suitable for assembly and manufacture, in accordance with the present disclosure, also would be appropriate.

Catheter 10 may be installed in a subject through a subcutaneous tunneling procedure as disclosed in U.S. Pat. No. 4,832,687 to Smith, III and U.S. Pat. No. 5,944,732 to Raulerson, the entire contents of each of the '687 patent and the '732 patent being incorporated herein by reference. In one preferred embodiment, catheter 10 in implanted within a major vein of a patient via the reverse tunneling method disclosed in U.S. Pat. No. 5,509,897 to Twardowski, the entire contents of the '897 patent being incorporated herein by reference.

With initial reference to FIG. 11, extension tubes 16,18 with clamps 20 removed are placed in juxtaposed side by side relation as shown. As indicated hereinabove, the effective length of extension tube 16 and its adapter 56 is substantially equal to or less than the length of extension tube 18 such that the tubes 16,18 may be placed in side by side relation as shown in FIG. 11. Thereafter, extension tubes 16,18 may be optionally twisted onto each other to the configuration of FIG. 12. The twisting of extension tubes 16,18 serves to effectively secure the extension tubes 16,18 to each other thereby minimizing radial movement of the extensions tubes 16,18 during passage through the subcutaneous tunnel. In addition, with the extension tubes 16,18 secured, a tunneling or trocar instrument may be attached to a leading adapter 56 to facilitate passage of both extension tubes 16, 18 through the created tunnel.

With reference to FIG. 13, a tunneling or trocar instrument 100 is operatively connected to the proximal or free ends of extension tubes 16,18 to effectively couple the tunneling instrument to catheter 10. In one preferred embodiment, tunneling instrument 100 includes mounting means in the form of, e.g., an internal threaded or cam lock 102, which cooperates with corresponding external thread 58 of adapter 56 to secure the tunneling instrument 100 to catheter 10. As a further alternative, a flexible sheath 200 may be positioned around the juncture or connection area of tunneling instrument 100 and adapter 56, preferably encompassing both adapters 56 as shown in FIG. 14. Sheath 200 facilitates passage of tunneling instrument 100 and catheter 10 through the subcutaneous tunnel by providing a smooth and flexible outer member which may readily traverse the created subcutaneous tunnel. Sheath 200 is preferably flexible and elastic to stretch and tightly fit over the components. FIG. 15 illustrates sheath 200 and with various features, for example, extension tab 202 which may be readily grasped to draw the sheath 200 back onto extension tube 16,18 once exposed from the tunnel. Slits or notches 204 in the sheath 200 are also envisioned. A tear away capability, for example along perforated or score line 206 may also be incorporated with sheath 200.

The use of system 10 will now be discussed in terms of a back end or reversed tunneling procedure in connection with hemodialysis treatment. In this regard low profile catheter 10 functions as a hemodialysis catheter. However, it is envisioned that the system may be used for other surgical treatments and in other deployment procedures. The preferred method will be discussed in terms of deployment of catheter 10 through the right jugular vein for positioning of within the right atrium. As appreciated, catheter 10 may be implanted in the right atrium via the left jugular vein, the right atrium through the right subclavian vein, the right atrium through the left subclavian vein, or implanted in the femoral vein of the subject.

Referring now to FIG. 16, an incision or entry opening 500 is made adjacent the midclavicular line, through the skin and the subcutaneous tissue. The internal jugular vein 502 is punctured using known techniques and leading end 44 of catheter 10 in inserted through the internal jugular vein 502, the superior vena cavity 504 and into the right atrium 506. The positioning of leading end 44 may be confirmed with an x-ray if desired. Thereafter, a subcutaneous tunnel is made with, e.g., a tunneling device or trocar from the first incision area or entry opening area 500 downwardly to a lower chest area. A small exit opening 508 is made at the base of the subcutaneous tunnel. Thereafter, tunneling instrument 100 with attached catheter 10 and sheath 200 of FIG. 14 is maneuvered through the tunnel which correspondingly draws adapters 56, extension tubes 16,18, catheter hub 12 and the proximal end of elongated catheter member 14 through the tunnel toward the exit opening 508 as shown in FIG. 17. As appreciated, the narrow profile of catheter hub 12 facilitates passage of the catheter hub 12 through the subcutaneous tunnel. Tunneling instrument 100 is removed from adapter 56. With adapters 56, extension tubes 16, 18 and catheter hub 12 exposed from the exit opening 508, sheath 200 may be pulled back onto itself or removed to expose adapters 56 for connection to the appropriate fluid supply lines. FIG. 18 illustrates sheath 200 in the process of being pulled back on itself to expose adapters 56. As indicated hereinabove, extension tab 202 or notches 204 may be employed to facilitate this procedural step. Also, sheath 200 may be removed or separated from the components along, e.g., score line 206.

In a hemodialysis application, one adapter 56 may be connected to the hemodialysis machine to withdraw blood through, e.g., longitudinal lumen 38 and extension tube 16. The remaining adapter 56 is intended to return the blood through extension tube 18 and longitudinal lumen 40 for delivery to the right atrium area. Clamps 20 may be then mounted about extension tubes 16,18 and assembled in the manner discussed hereinabove. Clamps 20 may be manipulated between their respective first open and second closed positions as desired.

Although the illustrative embodiments of the present disclosure have been described herein with reference to the accompanying drawings, it is to be understood that the disclosure is not limited to those precise embodiments, and that various other changes and modifications may be effected therein by one skilled in the art without departing from the scope or spirit of the disclosure. 

What is claimed is:
 1. A method for performing a surgical procedure, comprising the steps of: providing a catheter assembly including a catheter hub and an elongated catheter extending distally from the catheter hub, the elongated catheter having at least one longitudinal lumen for passage of fluids, the catheter hub having a housing section comprising distal and proximal ends, the distal end having at least one internally defined lumen configured to receive the proximal end of the elongated catheter, the proximal end having internally defined lumens configured to receive at least one extension tube; advancing a distal end of the elongated catheter through a first opening and into a patient; creating a surgical tunnel from the first opening and out through a second opening in the skin remote from the first opening; and passing the catheter assembly through the surgical tunnel by introducing the catheter hub through the first opening and advancing the catheter hub with the elongated catheter following there along within the surgical tunnel.
 2. The method according to claim 1 wherein the step of creating the surgical tunnel includes providing a tunneling instrument and passing the tunneling instrument between the first opening and the second opening.
 3. The method according to claim 2 including the step of operatively connecting the catheter hub with the tunneling instrument and wherein the step of passing the catheter assembly includes advancing the tunneling instrument from the first opening to the second opening to form the surgical tunnel between the first opening and the second opening, wherein advancement of the tunneling instrument causes corresponding advancement of the catheter hub through the surgical tunnel.
 4. The method according to claim 3 wherein the catheter assembly includes at least one extension tube, the at least one extension tube extending proximally from the catheter hub and wherein the step of operatively connecting the catheter hub includes the step of coupling the at least one extension tube with the tunneling instrument.
 5. The method according to claim 4 wherein the at least one extension tube includes a fluid connector and wherein the step of coupling the at least one extension tube includes coupling the tunneling instrument with the fluid connector.
 6. The method according to claim 5 wherein the fluid connector of the at least one extension tube and the tunneling instrument include cooperative coupling means and wherein, during the step of coupling the tunneling instrument with the fluid connector, the cooperative coupling means are coupled.
 7. The method according to claim 4 wherein the elongated catheter defines first and second longitudinal lumens and the method further includes the step of fluidly coupling each of the first and second longitudinal lumens with an external device.
 8. The method according to claim 7 wherein the at least one extension tube includes first and second extension tubes, the first and second extension tubes extending proximally from the catheter hub and being in fluid communication with the respective first and second longitudinal lumens and wherein the step of fluidly coupling includes the step of coupling the first and second extension tubes with an external device.
 9. The method according to claim 8 further including the step of positioning a sheath at least partially about the fluid connector of the first and second extension tubes and an end portion of the tunneling instrument.
 10. The method according to claim 3 wherein the step of passing the catheter assembly includes at least partially exposing the catheter hub through the second opening.
 11. The method according to claim 10 wherein the step of passing the catheter assembly includes at least partially removing the catheter hub from the surgical tunnel through the second opening.
 12. The method according to claim 10 wherein the catheter assembly includes at least one extension tube, the at least one extension tube extending proximally from the catheter hub and further including the step of mounting a clamp about the at least one extension tube, the clamp being adapted to move from a first position to a second position to substantially close a lumen of the at least one extension tube.
 13. The method according to claim 12, wherein the clamp includes first and second clamp sections defining a longitudinal clamp axis, the first clamp section defining a longitudinal opening and including at least one cutaway portion in a body of the first clamp section which communicates with the longitudinal opening to facilitate lateral passage of the at least one extension tube into the longitudinal opening, the first clamp section including a movable member adapted to move from a first position to a second position to substantially close the internal lumen of the at least one extension tube, the first and second clamp sections being separable to facilitate positioning of the at least one extension tube within the longitudinal opening through the at least one cutaway portion, the first clamp section being releasably mountable to the second clamp section to cover the cutaway portion and enclose the longitudinal opening when the movable member is in the first position, and further including the step of mounting the first clamp section to the second clamp section.
 14. The method according to claim 13, wherein the at least one longitudinal lumen of the catheter hub includes a first lumen which extends about a first axis parallel to a longitudinal axis of the elongated catheter and a second lumen defining a second axis which defines an angle b with respect to the first axis, wherein b is between 0° and about 45°.
 15. The method according to claim 14, wherein b is between about 5° and about 20°.
 16. A method for performing a surgical procedure, the method comprising the steps of: providing a catheter assembly including a catheter hub, an elongated catheter extending distally from the catheter hub, and at least one extension tube extending proximally from the catheter hub, a proximal end of the at least one extension tube having a fluid connector, and the elongated catheter having at least one longitudinal lumen for passage of fluids; advancing a distal end of the elongated catheter through a first opening in the skin of a patient and into the patient; creating a surgical tunnel from the first opening and out through a second opening in the skin, the second opening remote from the first opening; and passing the catheter assembly through the surgical tunnel by introducing the fluid connector through the first opening and advancing the fluid connector with the at least one extension tube, the catheter hub, and the elongated catheter through the surgical tunnel.
 17. The method according to claim 16, wherein the at least one extension tube includes a plurality of extension tubes, each one of the extension tubes having a fluid connector on the proximal end and each of the extension tubes being of different length to offset the fluid connectors along a longitudinal axis of the catheter.
 18. The method according to claim 17, wherein the step of creating the surgical tunnel includes providing a tunneling instrument, including operatively connecting at least one of the fluid connectors with the tunneling instrument, and passing the tunneling instrument between the first opening and the second opening, wherein advancement of the tunneling instrument causes corresponding advancement of the catheter hub, the plurality of extension tubes, and the fluid connectors through the surgical tunnel.
 19. The method according to claim 18, wherein the step of creating the surgical tunnel further includes twisting the extension tubes about each other.
 20. The method according to claim 19, wherein the fluid connector of the extension tube and the tunneling instrument include cooperative coupling means and wherein, during the step of operatively connecting the tunneling instrument with the fluid connector, the cooperative coupling means are coupled.
 21. A method for performing a surgical procedure, the method comprising the steps of: providing a catheter assembly including a catheter hub and an elongated catheter extending distally from the catheter hub, the catheter hub being substantially rigid, the catheter hub having a housing section comprising distal and proximal ends, the distal end having at least one internally defined lumen configured to receive the proximal end of the elongated catheter, the proximal end having internally defined lumens configured to receive at least one extension tube, the elongated catheter having at least one longitudinal lumen for passage of fluids; advancing a distal end of the elongated catheter through a first opening in the skin of a patient and into the patient; creating a surgical tunnel from the first opening and out through a second opening in the skin, the second opening remote from the first opening; and passing the catheter assembly through the surgical tunnel by introducing the catheter hub through the first opening and advancing the catheter hub with the elongated catheter following the catheter hub within the surgical tunnel. 